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Opthamology E/M vs Regular E/M

  1. #1
    Red face Opthamology E/M vs Regular E/M
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    I work at a Hudson Valley Hospital doing outpatient coding and we recently got word that Optometry can now use regular E/M codes if they want to.
    Has anyone else heard of this?
    It seems as though eye exams have E/M codes (92002-92004, 92012-92014) specific to their subject matter and those are better suited for eye exams than the regular E/M office/outpatient codes.
    Any help/advice on this matter is greatly appreciated.
    Thanks
    Jazmine

  2. #2
    Location
    Lexington Kentucky Chapter
    Posts
    105
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    Quote Originally Posted by jazmine29 View Post
    I work at a Hudson Valley Hospital doing outpatient coding and we recently got word that Optometry can now use regular E/M codes if they want to.
    Has anyone else heard of this?
    It seems as though eye exams have E/M codes (92002-92004, 92012-92014) specific to their subject matter and those are better suited for eye exams than the regular E/M office/outpatient codes.
    Any help/advice on this matter is greatly appreciated.
    Thanks
    Jazmine
    Our Optometry physicians can and do bill both E/M and Eye codes, depending on the nature of the presenting problem. The only thing they are prevented by law in the state of Kentucky from doing is prescribing certain medications and performing many surgical procedures.

    David Keown, CPC, OCS

  3. #3
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    Thank you for your response. Quick question: do they use the regular E/M codes when performing a typical eye exam? Or are there other certain circumstances when they use the regular E/M codes (as opposed to the ones specific for eye exams)?

  4. #4
    Location
    Lexington Kentucky Chapter
    Posts
    105
    Default
    It all depends on why the patient presents for examination, but typically they will use the eye codes for their patients. That said, if a patient presents for a corneal ulcer, then they normally will code an E/M for the visit with the appropriate ICD code.

  5. #5
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    You need to meet the requirement of the 92... codes to bill. If you don't then you revert to an E&M code. I use an audit sheet when in doubt.

  6. #6
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    Ophthalmology & optometry can use both e/m codes and vision codes. Part of the reason is because some medical insurances will not accept vision codes (92...) when billed with a medical diagnosis. they Associated e/m with medical & 92... codes as vision exam only (routine exams/annual exams).
    Jennifer DeWitte, CPC, CPC-P, CPB, AAPC Fellow
    Newport Center Surgical
    Coding & Billing Department
    Vice President
    AAPC Fullerton, CA Chapter

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